Search

ObjectivePrevious studies have associated dietary patterns with diabetes risk in Western countries, but such studies among the Japanese population are scarce. The present study aimed to investigate dietary patterns associated with abnormal glucose tolerance determined by elevated glycated Hb (HbA1c) levels.DesignThe 2012 National Health and Nutrition Survey (NHNS) database was used for the cross-sectional study. Dietary patterns were analysed by factor analysis of twenty-five food items from the dietary intake survey and household-based semi-weighed dietary records. OR and 95 % CI for elevated HbA1c levels (≥6·5 %) according to dietary patterns were estimated using logistic regression models.SettingJapan.ParticipantsThe study population comprised 9550 Japanese aged ≥40 years registered in the nationwide NHNS.ResultsThree dietary patterns were identified: (i) high-bread and low-rice; (ii) high-meat and low-fish; and (iii) vegetable. The high-bread and low-rice pattern, characterised by high frequent consumption of bread, milk and dairy products, and fruits, and low rice intake, was associated with marginally decreased prevalence of elevated HbA1c levels (P trend=0·047). The vegetable pattern, characterised by vegetables, mushrooms, soyabeans and soybean products, was significantly inversely associated with elevated HbA1c levels (4th v. 1st quartile: multivariable OR=0·68; 95 % CI 0·49, 0·95; P trend=0·007).ConclusionsOur findings suggest that the vegetable pattern is associated with decreased prevalence of elevated HbA1c levels among Japanese.

Mid-to-late gestation is a unique period in which women experience dynamic changes in lipid metabolism. Although the recent intensive epigenome-wide association studies (EWAS) using peripheral leukocytes have revealed that lipid-related traits alter DNA methylation, the influence of pregnancy-induced metabolic changes on the methylation levels of these differentially methylated sites is not well known. In this study, we performed a prospective cohort study of pregnant women (n = 52) using the MassARRAY EpiTYPER assay and analyzed the methylation levels of variably methylated sites, including CPT1A intron 1 and SREBF1 intron 1 CpGs, which were previously verified to be robustly associated with adiposity traits. Although methylation of SREBF1 was associated with body mass index (BMI) and low-density lipoprotein cholesterol at mid-gestation, this association was attenuated at late gestation, which was consistent with the metabolic switch from an anabolic to a catabolic state. However, the BMI association with CPT1A intron 1 methylation appeared to strengthen at late gestation, this association was mediated by pre-pregnancy BMI-dependent change in the leukocyte proportion during mid-to-late gestation. Thus, the methylation of adiposity-related differentially methylated regions was sensitive to metabolic and immunological changes during mid-to-late gestation.

OBJECTIVES: Dish based nutrient profile analyses are essential in setting goals to achieve a balanced diet. The Japanese enjoy longevity, but their current diet is still high in salt, which was 10.1g/day among adults in the 2019 National Health and Nutrition Survey. In 2013, the Japanese government's “Health Meal” proposed the salt content of 3g/650 kcal per meal. However, studies are scarce regarding the nutrient profiles of the dishes eaten by the general population, especially who exceed the current standard. In order to examine the current achievement status and related nutritional problems among a nationally representative sample, we conducted the secondary analyses of the 2013–2018 National Health and Nutrition Survey data. METHODS: Dietary data from 35,915 participants in the 2013–2018 National Health and Nutrition Survey aged 18–74 years who ate three meals on the survey day, were applied for analyses. We extracted 554,257 dishes from each meal, and categorized them according to the definition of “staple dish” (grain dish), “main dish”(meat, fish, eggs, or beans), and “side dish”(vegetables, seaweeds, potatoes, or mushrooms) shown in the 2005 “Japanese Food Guide Spinning Top”. Participants were grouped as “high salt” consumers if their intake were 3g/650kcal or higher, and “adequate” consumers if they consumed less. The nutrient profile of each dish category was compared between the two groups by using the Wilcoxon's signed rank test. RESULTS: 22 300 participants were identified as “high salt” and 13 615 as “adequate”. The mean age of the “high salt” group (53.2 years) was higher than the “adequate” group (50.5 years), but their mean energy intake was similar (1901 and 2081 kcal/day, respectively). The mean salt intake in the “high salt” group was 11.8 g/day and the “adequate” group was 7.7 g/day. Among the dishes, 59 936 were categorized as “staple dish”, 47 081 as “main dish”, 45 828 as “side dish”, 30 151 as “combined dish”, and 371 261 as “miscellaneous”. Except for “staple dish”, dishes consumed by the “high salt” group were significantly low in energy and fat but high in salt, compared to the “adequate”. CONCLUSIONS: Older participants were more likely to consume dishes high in salt, but low in fat. Examples of balanced dishes low in both salt and fat could be proposed for further diet modification. FUNDING SOURCES: Ministry of Health, Labour and Welfare research grant.

DNA polymerase ζ (pol ζ) is involved in translesion replication (translesion synthesis, TLS) and plays an essential role in embryogenesis. In adults, pol ζ triggers mutation as a result of error-prone TLS and causes carcinogenesis. The catalytic subunit of pol ζ, REV3, is evolutionarily conserved from yeast and plants to higher eukaryotes. However, the structures are notably different: unlike that in yeast REV3, a large intermediate domain is inserted in REV3 of humans and mice. The domain is mostly occupied with noncommittal structures (random coil…etc.); therefore, its role and function are yet to be resolved. Previously, we reported deficient levels of ultraviolet (UV)-induced TLS in fibroblasts derived from the Rev3-knockout mouse embryo (Rev3KO-MEF). Here, we constructed a mouse Rev3-expressing plasmid with a deleted intermediate domain (532-1793 a.a,) and transfected it into Rev3KO-MEF. The isolated stable transformants showed comparable levels of UV-sensitivity and UV-TLS activity to those in wild-type MEF, detected using an alkaline sucrose density gradient sedimentation. These results indicate that the intermediate domain is nonessential for UV-induced translesion replication in cultured mouse cells.

The relationship between free sugars intake and cardiometabolic risk factors is unclear in Japanese adults. This cross-sectional study aimed to investigate this association using data from the 2016 National Health and Nutrition Survey, Japan. The percentage of energy intake from free sugars was estimated based on the 1-day weighed dietary record data of Japanese men (n = 4071) and women (n = 5794) aged &ge, 20 years. Associations between free sugars intake and cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures, glycated haemoglobin (HbA1c) level and levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, were investigated using linear regression and Dunnett&rsquo, s test, with the lowest category of quartiles as a reference. After adjustment for potential confounding factors, free sugars intake was inversely associated with blood pressures (men only) and HDL-cholesterol level (both sexes) and positively associated with total-cholesterol level (women only) and LDL-cholesterol level (both sexes), whereas no association was observed for BMI, WC, and HbA1c level. This study identified both positive and inverse associations of free sugars intake with cardiometabolic risk factors in Japanese adults.

Objective To investigate the association between several types of soy products and all cause and cause specific mortality. Design Population based cohort study. Setting Japan Public Health Centre-based Prospective Study, which includes 11 public health centre areas in Japan. Participants 92 915 participants (42 750 men and 50 165 women) aged 45 to 74 years. Exposures Intake of total soy products, fermented soy products (natto and miso), non-fermented soy products, and tofu from a five year survey questionnaire. Main outcome measures All cause and cause specific mortality (cancer, total cardiovascular disease, heart disease, cerebrovascular disease, respiratory disease, and injury) obtained from residential registries and death certificates. Results During 14.8 years of follow-up, 13 303 deaths were identified. In the multivariable adjusted models, intake of total soy products was not significantly associated with total mortality. Compared with the lowest fifth of total soy product intake, the hazard ratios in the highest fifth were 0.98 (95% confidence interval 0.91 to 1.06, Ptrend=0.43) in men and 0.98 (0.89 to 1.08, Ptrend=0.46) in women. Intake of fermented soy products was inversely associated with all cause mortality in both sexes (highest versus lowest fifth: 0.90 (0.83 to 0.97), Ptrend=0.05 in men, and 0.89 (0.80 to 0.98), Ptrend=0.01 in women). Natto showed significant and inverse associations with total cardiovascular disease related mortality in both sexes. Conclusions In this study a higher intake of fermented soy was associated with a lower risk of mortality. A significant association between intake of total soy products and all cause mortality was not, however, observed. The findings should be interpreted with caution because the significant association of fermented soy products might be attenuated by unadjusted residual confounding.

While previous studies have reported the association between food portion size and health outcomes, the association between food seasonings and blood pressure (BP) has not been clarified. This study aimed to investigate the association between the portion sizes of traditional Japanese seasonings and BP. Data on 25,738 Japanese participants (10,154 men and 15,584 women) aged &ge, 20 years registered in the 2012&ndash, 2016 National Health and Nutrition Survey (NHNS) were used for this cross-sectional study. The portion sizes of soy sauce or miso were calculated from the reported weight of soy sauce or miso, and the number of dishes. Regression models were used to estimate BP and prevalence of hypertension, and their 95% confidence intervals according to the portion size of soy sauce or miso. We did not observe an association between the portion sizes of soy sauce or miso and BP. A larger portion size of soy sauce or miso was associated with a higher prevalence of hypertension in the crude model among women, but no significant associations were observed in the multivariate model in both sexes. Our findings suggest that the portion sizes of soy sauce or miso are not associated with BP among Japanese adults.

Recent studies have analyzed dietary patterns to assess overall dietary habits, but there have been no studies of dietary patterns among the contemporary Japanese population nationwide. The objective of this study was to identify dietary patterns based on consumption of food items among Japanese adults, and to examine whether these dietary patterns were associated with nutrient intake, demographic characteristics, and lifestyle factors.The study population included 25,754 Japanese adults aged 20 years and older registered in the nationwide National Health and Nutrition Survey database in 2012. Dietary patterns were analyzed by factor analysis of 29 food items from the dietary intake survey and household-based semiweighed dietary records.Five dietary patterns were identified: high-bread and low-rice, high-meat and low-fish, vegetable, wheat-based food, and noodle and alcohol patterns. The lowest quartile of factor scores for high-meat and low-fish, wheat-based food, and noodle and alcohol patterns had higher nutrient intakes, and the highest quartile of factor scores for the vegetable pattern had a higher nutrient intake overall (all p0.01). Dietary pattern scores were associated with demographic and lifestyle factors such as sex, age, region, smoking status, and alcohol intake.Five major dietary patterns among Japanese adults were identified by factor analysis. Dietary pattern scores were associated with differences in nutrient intakes and demographic and lifestyle factors. These patterns were further used for examining the association between Japanese diets and health outcomes.

Little is known about the association between dietary patterns and cardiovascular disease risk factors among Japanese adults based on nationally representative data. This study aimed to explore the association between dietary patterns and hypertension or blood lipid profiles among Japanese people.De-identified Japan National Health and Nutrition Survey (NHNS) 2012 data with a total of 8721 subjects (3524 men and 5197 women) aged 40-74 years were used. Dietary patterns were derived by principal component analysis (PCA). Generalized linear models and multivariate logistic regression analysis were used to assess the relationship between dietary patterns and blood pressure or lipid profiles.We identified four dietary patterns: (a) traditional Japanese, (b) bread-dairy, (c) meat-fat, and (d) noodle patterns. Among these, the traditional Japanese pattern was significantly related to lower blood pressure, lower low-density lipoprotein (LDL)-cholesterol in men and lower high-density lipoprotein (HDL)-cholesterol in women. Bread-dairy pattern was associated with high total cholesterol in women and higher LDL cholesterol in both men and women. Noodle pattern was associated with higher total cholesterol and HDL-cholesterol in men. No significant association was observed between meat-fat pattern and blood pressure or lipid profiles.Our study showed that the traditional Japanese pattern with high intake of miso, soy-sauce, vegetables, beans, potatoes and mushroom conferred benefits on blood pressure. Our findings have indicated clearly that it is possible to provide useful information on healthy dietary pattern for health promotion from the one-day dietary records of the NHNS.

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women.Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes.Pre-pregnancy underweight was present in24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores7.Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

To evaluate protein and amino acid intakes and distribution among Japanese people in terms of prevention of sarcopenia or frailty.We carried out a cross-sectional study using data from Japan's 2012 National Health and Nutrition Survey. From the original dataset, we selected individuals aged ≥30 years, who were not pregnant or lactating, and for whom dietary intake, bodyweight and body height data were available. Protein intake was calculated using exclusive software developed for the survey. Amino acid intake was calculated using the database created by the National Institute for Longevity Sciences.More than 95% of the participants met recommended levels of protein suggested by the Dietary Reference Intake in Japan. However, nearly half of the participants did not meet recommended levels in terms of prevention of sarcopenia. Leucine intake was not sufficient for each sex and age group, probably because of decreased intake of animal protein, especially protein from milk and dairy products. Distribution of protein and leucine in each meal tended toward dinner.The Japanese population might have insufficient quality, quantity and distribution of protein intake required to prevent sarcopenia or frailty. Geriatr Gerontol Int 2018; 18: 723-731.

Background There is an increasing global interest in the role of Japanese diet as a possible explanation for the nation’s healthy diet, which contributes to the world’s highest life-expectancy enjoyed in Japan. However, nationwide studies on current food intake status among general Japanese population have not been established yet. This study examined the association between food intake patterns and cardiovascular risk factors (CVRF) such as waist circumference (WC), body mass index (BMI), blood pressure (SBP, DBP), HbA1c and blood lipid profiles among general Japanese adults. Methods De-identified data on the Japan National Health and Nutrition Survey (NHNS) 2012 with a total of 11,365 subjects aged 20–84 years were applied. Food intake patterns were derived by principal component analysis (PCA) based on 98 food groups. Generalized linear regression analysis was used to assess the relation between the food intake patterns and CVRF. Results We identified three food intake patterns: traditional Japanese, Westernized, and meat and fat patterns. Traditional Japanese pattern was significantly related to high WC and BMI in men, and high DBP in women. Westernized pattern was associated with lower SBP, but high total cholesterol and LDL cholesterol in both men and women. Meat and fat pattern was associated with high WC, high BMI, high blood pressure and blood lipid profiles in both men and women (trend P

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan's national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Aim To provide updated growth references for Japanese children from birth to 6 years of age, for use in both growth monitoring and child care. Methods We analysed data from two national representative surveys that provided cross-sectional data on 3000 areas in the 2005 national census and longitudinal data from 136 hospitals. Growth references for length/height, weight, head circumference and chest circumference were constructed using the lambda-mu-sigma (LMS) method, with estimates of the L, M and S parameters. These updated values were then compared with growth references published by the World Health Organization. Results The 3rd, 50th and 97th smoothed percentile values of length/height, weight, head circumference and chest circumference for boys and girls from birth to 6 years are presented. The comparisons show some large differences in median measurements between the charts. Conclusion Our growth references are based on a current, nationally representative sample of Japanese children. The results provide deep insight into child growth from a historical, ethnic and environmental point of view.

Background: The health care field is focusing considerable attention on dietary control, which requires that individuals record what they eat. We have developed a novel smartphone application called FoodLog, a multimedia food recording tool that allows users to take photos of their meals and to produce textual food records. Unlike conventional smartphone-based food recording tools, FoodLog allows users to employ meal photos to help them to input textual descriptions based on image retrieval. In this study, we conducted usability experiments to evaluate the routine daily use of FoodLog systems with and without image-based assistance. Methods: We produced 2 food recording tools: FoodLog with image-based assistance (FL-I) and FoodLog with text input only (FL-T). We recruited 18 university students (age = 18-24 years), all of whom performed food recording for the first time. The participants used FoodLog on a daily basis for 1 month. Results: In the subjective evaluation, FL-I had higher average scores for questions related to ease of use, fun, frequency of browsing, and intention to continue. In particular, the latter 3 factors received significantly higher scores with FL-I than with FL-T. In the quantitative evaluation, the daily average number of meal events and food records did not differ significantly between FL-I and FL-T. A detailed analysis of the individual records showed that 1 participant produced 3 times as many records using FL-I compared with FL-T. Conclusions: The subjective assessment showed that our new tool, which fully exploits the use of images, is a promising method for food recording.

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5-10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child's body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08-5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16-0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

The Japanese government has set 11 targets to promote "Shokuiku." However, among the 11 targets, only two targets (frequency of shared family meals and the proportion of breakfast skipping in children and young men) are quantitative goals. The increase in children eating alone is often lamented in the popular media, but the methodology for identifying the status of family meals ("Kyoshoku"), or how the responses should be validated, is rarely discussed. In the current review, we attempt to clarify how a family meal and survey responses are defined, by searching literature published after 2009, using the following keywords: "family meals" or "shared meals," in the PubMed database for English. For literature published in Japanese, we searched the Igakuchuo-Zassi Database and Google Scholar for relevant studies. In the English literature, questions were likely to focus on whether a dinner or any meal was eaten together with family members living together, while Japanese literature was more focused on "breakfast or dinner" eaten together with family members. The response options varied across different studies, such as the number of family meals a week, or the number of days (per week) these family meals were eaten. We found it quite difficult to compare across the studies, as there is no standardized definition or response options for "family meals." Further studies are needed in order to develop a standardized method to assess the current status of "family meals."

Salt reduction is one of the most important lifestyle modifications for the prevention of hypertension. The health promotion law regulates the labeling of the nutrient content of food in Japan and, the level of sodium, not salt (sodium chloride), has to be printed on the labels of manufactured foods. In order to control their salt intake, consumers need to apply a conversion factor to the sodium levels listed on the labels to obtain the salt equivalent. However, it is not known whether people have the knowledge appropriate for making the conversion. We carried out a questionnaire survey at the 7th National Shokuiku (food education) Conference in 2012, asking subjects to determine the salt equivalent of 1000 mg of sodium on food labels. We also asked about the target values of salt reduction in grams in the Dietary Reference Intakes for Japanese 2010 (DRI2010) and the Guidelines for Management of Hypertension 2009 by the Japanese Society of Hypertension (JSH2009). We analyzed the data from 683 respondents (169 men and 514 women); only 13.3% of respondents gave a correct answer for the salt equivalent of 1000 mg of sodium (2.50-2.60 g), whereas 61.8 and 40.4% of respondents chose the correct target values for salt reduction according to DRI2010 and JSH2009, respectively. In conclusion, few people could convert sodium content to salt, which suggested difficulty in using food labels to control their salt intake. Salt content in grams, not sodium content, should be labeled on food packages for effective salt reduction and prevention of hypertension.

The Adequate Intake (AI) values in the Dietary Reference Intakes for Japanese (DRIs-J) 2010 were mainly determined based on the median intakes from 2 y of pooled data (2005-2006) from the National Health and Nutrition Survey-Japan (NHNS-J). However, it remains unclear whether 2 y of pooled data from the NHNS-J are appropriate for evaluating the intake of the population. To clarify the differences in nutrient intakes determined from 2 and 7 y of pooled data, we analyzed selected nutrient intake levels by sex and age groups using NHNS-J data. Intake data were obtained from 64,624 individuals (age: ≥1 y; 47.4% men) who completed a semi-weighed 1-d household dietary record that was part of the NHNS-J conducted annually in Japan from 2003 to 2009. There were no large differences between the median intakes calculated from 2 or 7 y of pooled data for n-6 or n-3 polyunsaturated fatty acids (PUFAs), vitamin D, pantothenic acid, potassium, or phosphorus. When the AI values and median intakes were compared, there was no large difference in the values for n-6 or n-3 PUFAs, pantothenic acid, or phosphorus. Conversely, the AI values for vitamin D and potassium differed from the median intakes of these nutrients for specific sex and age groups, because values were not based on NHNS-J data. Our results indicate that 2 y of pooled data from the NHNS-J adequately reflect the population's intake, and that the current system for determination of AI values will be applicable for future revisions.

Survey items of the Japan National Nutrition Survey (J-NNS) have changed over time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions.We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012. The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others.Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin measurements have been performed continuously for more than 20 years.This is the first report on the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply country-by-country comparisons.背景和目的：日本国民营养普查(J-NNS)项目随时间变化。关于饮食调查的几 篇论文已经发表，但是，到目前为止，还没有关于体检的进一步论文发表。因 此，我们研究了J-NNS 和国民健康和营养普查（NHNS）中体检项目的变化， 为进一步的政策制定提供有用的数据。方法与研究设计：我们总结了从1946 年J-NNS 到2012 年NHNS 体检项目的变化。体检大致分为以下六个部分：人 体测量相关参数、临床测量、身体症状、血液检测、生活方式和药物治疗及其 它。结果：根据总部的建议，早期就已经收集与营养缺乏有关内容，如贫血、 肌腱反射消失和体重测量。从1989 年开始，增加了血液检测和身体活动的测 量，血清总蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、血糖、红细胞 和血红蛋白，已连续检测20 多年。结论：这是J-NNS 更名为NHNS 后的第一 份关于体检的报告。我们的研究结果为研究人员、临床医生和政策决策者使用 J-NNS 和NHNS 提供了基本信息。正确监测当前状态是国民健康促进的必要手 段；也可改善普查方法，从而适用于国与国之间的相互比较。.

A daily mineral supplement is useful for those who are at risk of a deficiency. Some Western reports suggest that mineral supplement users have healthy behaviors and are not mineral-deficient. It is unknown whether the same phenomenon is observed in Japan where there is a different dietary culture. The aim of this study was to examine the characteristics of personal behaviors including food consumption nationwide among mineral supplement users from the National Health and Nutrition Survey in Japan 2003-2010.Data were obtained from 16,275 adults aged 20-59 years who completed sociodemographic, health status, and 1-day household dietary assessments. Supplement users were compared with non-users. Logistic regression models were utilized to identify the characteristics of food consumption and calcium and iron supplement use, using the medium intake group as a reference.Overall, 2.1% and 1.4% of adults reported using calcium supplements and iron supplements, respectively. Calcium supplement users were more likely to be physically active, non-smokers, and eat less fat compared with non-users. Furthermore, they were more likely than non-users to consume a higher intake of calcium from foods such as tea, vegetables, seaweeds, and fruits. Iron supplement users were more likely than non-users to be non-smokers. These individuals tended to have a high intake of seaweeds and fruits.Japanese adults who had healthier behaviors were more likely to use mineral supplements, especially calcium. Mineral supplement users tended to choose healthy foods such as seaweeds and fruits, without considering their overall mineral consumption.背景与目的：每天补充矿物质对有缺乏风险的人是有用的。一些西方的报告表 明：矿物质补充剂使用者拥有健康的行为，并且没有矿物质缺乏。但在有不同 饮食文化的日本，是否也存在同样的现象还不知道。本研究的目的是探讨 2003-2010 年全国健康与营养调查中矿物质补充者食物消费的个人行为特点。 方法与研究设计：从16275 名年龄为20-59 岁完成社会人口学、健康状况和一 天家庭膳食评估的成人中获得资料。补充剂使用者与未使用者进行比较。采用 logistic 回归模型确定食物消费、钙和铁补充剂使用的特点，以中等摄入量组作 为参考。结果：总体而言，分别有2.1%和1.4%的成人使用钙和铁补充剂。钙 补充剂的使用者比不用者更倾向于锻炼身体、不抽烟和少吃脂肪。此外，他们 比不补充者更可能从茶叶、蔬菜、海藻和水果等食物中摄入更多的钙。铁补充 者比不补充者更可能不吸烟，这些人往往摄入大量的海藻和水果。结论：日本 有健康行为的成人更可能使用矿物质补充剂，尤其是钙。不论矿物质补充剂使 用者总矿物质的消费量是多少，他们更倾向于选择海藻和水果等健康的食物。.

Background: Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids. Methods: Study subjects consisted of 103 infants who were born vaginally at term, with birthweight >2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty-four infants were breast-fed and 36 were formula-fed at 6 months. Results: Breast-fed infants demonstrated similar growth patterns compared with partially breast-fed or formula-fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol. Conclusions: Japanese breast-fed infants were more likely to be anemic at 6 months, while formula-fed infants were likely to have low serum lipid levels. Iron-fortified infant foods may be useful to prevent anemia in breast-fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula-fed infants.

Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy. GDM can cause significant problems including some perinatal complications, neonatal complications, and metabolic disorders to offspring in later life. The primary management mode for women with GDM is nutritional therapy. Some women with GDM need diet therapy alone, and some women require both diet therapy and insulin. Thus far, there is no universal dietary management of GDM, because there have been no universal diagnostic criteria and genomic backgrounds differ according to ethnicity. However, some consensus guidelines exist. This review details these consensus guidelines for the optimal nutritional management for GDM.

Aim: Greater antenatal weight or body mass index (BMI) gains may lead to larger fetuses and thus increase the risk for operative deliveries, such as cesarean deliveries. In order to examine the effect of weekly maternal weight and BMI changes on large-for-gestational-age (LGA) infants and cesarean delivery, delivery records from overall healthy women were analyzed. Materials and Methods: Singleton, term delivery records from January to December 2003, at three obstetric departments (urban, suburban, rural) in Japan (1617 records) were analyzed. Multivariate logistic regression analyses were applied in order to estimate the effect of maternal pre-pregnancy body size, higher maternal weight or BMI gains by calculating the odds ratios for LGA infants and cesarean deliveries. Results: Maternal pre-pregnancy overweight, primiparity, and BMI gains of more than 0.13 per week were independent factors positively related to LGA, and maternal underweight was negatively related. Urban hospital setting, maternal age 35 years or older, primiparity, and BMI gains of more than 0.13 per week independently increased the odds ratios for cesarean delivery. Weight or BMI gains between two-week intervals (26–28 weeks, 32–34 weeks) were not useful for predicting either LGA or cesarean delivery. LGA was unrelated to cesarean delivery risk. Conclusions: Applying BMI gains per week enables target weight gains to be set according to the mother's height, which may be useful in reducing risks for LGA and cesarean delivery, especially in shorter women. Further investigation may be needed to explore the practicality and effectiveness of advising women to gain weight according to their body height.

This study aimed to examine the association of fetal growth and elevated third trimester maternal serum folate due to folic acid (FA) supplement intake. Dietary intake, use of FA supplements, weight, and blood biomarkers of B-vitamins (serum folate, pyridoxal, vitamin B(12), and plasma total homocysteine) were observed in 33 healthy pregnant women at the third trimester (average gestational age 35 wk). Birth outcomes were assessed through hospital birth records. Infant anthropometry and maternal blood biomarkers were followed up at 1 mo postpartum. Fourteen women were taking FA supplements at the third trimester. Dietary intake was similar among FA users and non-users, but serum folate and pyridoxal were significantly higher in users (11.6±6.7 vs. 6.1±3.2 ng/mL, and 13.8±21.7 vs. 3.2±1.4 ng/mL, respectively). Plasma total homocystein (tHcy) was higher in non-users compared to users, but not significantly. Nine FA users and eight non-users had low serum vitamin B(12) values (

Maternal pregravid obesity is associated with adverse outcomes in pregnancy. There are many complications by maternal obesity during pregnancy, such as spontaneous abortion, congenital malformations, gestational hypertention, preeclampsia, gestational diabetes mellitus, fetal macrosomia, and so on. Also, at parturition, the prevalence of cesarean section and associated complications such as deep vein thrombosis, wound disruption, and infection increase. Further- more, offspring of obese women increases the risk of adolescent components of the metabolic syndrome. To improve short- and long-term adverse outcome associated with obese pregnant women, we need to encourage obese women to lose body weight before pregnancy. During pregnancy, weight gain should be limited to Institute of Medicine guidelines.

Adequate folate status in pregnancy is important for satisfactory pregnancy outcome.The objective of the present study was to evaluate folate status in healthy pregnant women by assessing dietary folate intakes and measuring changes in folate-related biomarkers including plasma tHcy, serum vitamin B(12) (B(12)), and serum and RBC folate concentrations in each trimester and to examine their relation to fetal growth.From 94 pregnant women, 3-day-dietary records were obtained and blood was collected for plasma total homocysteine (tHcy), serum B(12), and serum and red-blood cell (RBC) folate measurements. Infant anthropometric measurements were made immediately after birth.Average folate intake was less than 300 microg/day with a mean energy intake of about 1800 kcal. Mean serum and RBC folate concentrations declined significantly during gestation (p0.05). Mean serum B(12) also significantly decreased (p0.01), whereas plasma tHcy increased from 5.1 in the first trimester to 5.9 micromol/l in the third trimester (p0.01). Multiple regression analyses, after controlling for maternal age, parity and pre-pregnancy body-mass index indicated that a 1.0 micromol/l increase in plasma tHcy in the third trimester corresponded to a 151 g decrease in birth weight (p0.01). Neither B(12) nor folate concentrations in all three trimesters showed any significant associations with birthweight. Plasma pyridoxal-5'-phosphate concentrations were markedly low, and were consistent with low intake of vitamin B(6) in our population.Our data suggest that higher plasma tHcy in the third trimester is a predictor of lower birth weight. In general, the dietary intake of B-vitamins and energy may be inadequate in our population, suggesting intervention is necessary.

Optimal Weight Gain Recommendations For Non- Obese Japanese Pregnant Women To determine optimal weight gain recommendations for reducing unfavorable pregnancy outcomes in non-obese women, by comparing four different cutoffs for weight gains. Out of 4774 cases in the hospital-based survey of the 2010National Growth Survey of Preschool Children, data on 3547 singleton term deliveries with maternal pre-pregnancy BMI

To assess the status of dietary folate intake, serum and red blood cell (RBC) folate, and related nutritional biomarkers in healthy Japanese women in early pregnancy.A cross-sectional, observational study.Pregnant women in the first trimester, at 7-15 weeks gestation (n=70), who were not consuming any folate supplements or folate fortified foods.Three-day dietary records were obtained from each subject to assess dietary folate intake. Blood samples were collected for measurement of biomarkers. Biomarkers and nutrient intake were analyzed in two groups defined by their serum folate concentrations: the low folate group (serum folate9 ng/ml) and the high folate group (serum folateor = 9 ng/ml).Mean serum and RBC folate concentrations in all subjects were 10.3 and 519 ng/ml, respectively. These levels were remarkably higher than the reported values from many other countries despite our subjects receiving no folic acids supplements. However, mean folate intake by our subjects from natural foods was 289 microg/day, which is thought to be low according to the Japanese dietary recommendation specified for pregnant women. The intake of spinach and fruits was significantly greater in the high folate group than in the low folate group.Folate intake was thought to be adequate to maintain a desirable level of serum folate concentration in Japanese pregnant women in the first trimester, although the intake of folate from natural food was not high enough to meet the recommended daily intake.

Objective: To identify adequate weight gain ranges during pregnancy in Japanese women. Method: Obstetric records from 2001 to 2002 for 46,659 term, singleton, vaginally delivered live births was used to estimate IUGR and macrosomia risk. Total maternal weight gain was grouped according to gestational age-specific percentile values of weight gain as follows: “very low” (under the 25th), “low” (25th to 49th), “moderate” (50th to 74th), “high” (75th to 89th), and “very high” (90th and over). Results: About 6% of infants were identified as having IUGR and 0.9% as macrosomia. IUGR risk was elevated with low weight gains. Macrosomia risk was related to high weight gains and previous spontaneous abortions. Conclusion: Achieving weight gains between the 50th and 75th percentiles for gestational age was considered adequate for optimal fetal growth in Japanese pregnant women.

We analyzed the existing data from various surveys on the prevalence of spina bifida, birth weight, and body-mass index (BMI), dietary intake, and smoking habits of Japanese young women. We found that the increasing trend of the prevalence of spina bifida paralleled with the decrease in birth weight, and the decrease in BMI and dietary energy intake and the increase in smoking rate among women of childbearing age. The decreased energy intake is likely due to their distorted self-body image. Based on these findings, we hypothesize that lowering BMI in young women led to increasing prevalence of spina bifida and smaller babies in Japan. This low dietary intake possibly leads to poor folate nutritional status, a risk factor for the development of spina bifida, and increased smoking potentially accelerates these undesirable outcomes. Our hypothesis can be tested using two simultaneous approaches. The first step is an extensive educational campaign for young women to stop smoking, have a realistic body image and eat a sufficient balanced diet. Government officials and health-care workers are encouraged to establish an agenda to educate young women with emphasis on the importance of adequate nutrition during the critical period of reproduction. Together with this campaign, the distribution of folic acid tablets for the prevention of spina bifida can be tried in women of childbearing age through local health centers, which have been well established in Japan.

Aim: To describe the nutritional status in Japanese pregnant and lactating women at a national level, through a comparison with their non-pregnant/non-lactating controls. Material and methods: Pooled data from five years (1995–1999) of the National Nutrition Survey, Japan. Data on 330 pregnant and 388 lactating women, and their one-by-one matched non-pregnant/non-lactating controls, were used for analysis. Results: There were fewer smokers, drinkers, and exercisers in pregnant women compared to their controls (P

The present study was conducted to provide basic data for the new method of dietary assessment proposed in the National Nutrition Survey. This newly proposed method incorporates several new codes for ‘school lunch’, ‘fast food’, ‘dishes’, ‘seasoning’, ‘water’, ‘cooking’ and a food code table based on the 5th revision of the food composition table to implement in the 2001 National Nutrition Survey. We tested the coding of food consumption data by using this method and conducted a questionnaire about the introduction of this newly proposed method with dietitians at local public health centers. The percentage of errors for ‘seasoning codes’ (50%) was higher than that for the other new codes, while ‘cooking code’ errors were also high (23%). However, the needs for introducing ‘seasoning codes’ and ‘cooking codes’ in the National Nutrition Survey were considered high (80% and 61%, respectively). The percentage of errors for ‘water codes’ was relatively low compared with the others (39%). These results suggest that the newly proposed method should be improved to adapt more to the National Nutrition Survey, although we expect that such coding errors will be decreased by dietitian training and adjustment to the new method.

Obesity has become a public health problem in Japan. The National Nutrition Survey (2000) showed prevalence of preobese (body mass index: 25–29.9 kg/m2) and obesity (≥ 30 kg/m2) was 24.5% and 2.3%, respectively, in males, and 17.8% and 3.4%, respectively, in females aged 20 years and over. Trends in prevalence of overweight in the last 25 years differed among age-sex groups and across residential areas. The most significant increase in overweight was observed in men in small towns, whilst there was a remarkable decrease in women in metropolitan areas. In the 10 year national plan for health promotion named ‘Health Japan 21’, maintaining appropriate body weight (obesity control and prevention of thinness brought about by dieting in young women) is a core component of the prioritized issues. Increasing the number of people who know their healthy body weight and practice weight control is also listed as an important objective. The proportion of people engaged in regular exercise for health and following the recommended average number of steps in daily life is a major indicator for evaluation of the program. We conclude that when formulating effective public health strategies for obesity control, it is important to consider each country’s own situation related to obesity issues including the proper BMI cutoff point, which might be much different from that in western societies.

This study was performed to: (1) assess the prevalence of dietary supplement and fortified food use, (2) examine the differences in vitamin E intake with and without dietary supplementation and/or fortified food use, and (3) determine whether some individuals consume vitamin E above the tolerable upper intake level (UL). Data were obtained from 64,624 individuals (age, ≥1 y; 47.4% males) who completed a 1-d household dietary assessment that was part of the National Health and Nutrition Survey conducted in Japan, 2003-2009. The survey also obtained information on the brand or generic name of each dietary supplement or fortified food reported, including their ingredients, through dietary assessment. The prevalence of a potential risk of excess was estimated by the proportion of persons above the age-/sex-specific ULs provided by the Dietary Reference Intakes for Japanese 2010. Supplement use was reported by 5.8% of men and 7.7% of women, whereas fortified food consumption was reported by only 2.9% of men and 3.6% of women. Use of dietary supplements was most common among older women, whereas use of fortified foods was most common among younger women. Both dietary supplement and fortified food use accounted for maximum vitamin E intake; however, the use of dietary supplements and fortified foods had little effect on the median and 95th percentile intake values. None of the subjects consumed nutrients above the UL. The collected data confirm that the use of both dietary supplements and fortified foods contributes a small amount to nutrient intake in Japanese subjects.

In Asia, the concept of dietary reference values is shifting from recommended dietary allowances (RDAs) to dietary reference intakes (DRIs). To assist Asian countries that are planning to develop or revise their own DRIs, this study summarizes the scientific literature used in the development of the latest DRIs for the Japanese (DRIs-J 2010): it aims to clarify critical issues on- and discuss future prospects for DRIs in Asia. The criteria and studies used to determine reference values in DRIs-J 2010 in adults were extracted from the DRIs-J 2010 report, systematically classified, and summarized for each nutrient in tables according to the type of DRIs. The classification categories were as follows: criteria, subject ethnicity, year of publication, type of study and study design, number of subjects, and study content. In all, 184 studies were extracted and some issues in DRIs-J 2010 were clarified: 1) some nutrients were lacking in studies based on native populations; 2) only a few and relatively old studies determined tolerable upper intake levels for some nutrients; 3) with the same DRIs, there were inconsistencies among the nutrients in the study criteria. These were considered common issues when determining DRIs in other Asian countries. When establishing DRIs, these issues should be considered, in addition to population health status and country-specific needs.在亞洲，對膳食參考值的概念正從建議攝取量(RDAs)轉變成膳食營養素參考攝 取量(DRIs)。為了協助正計畫發展或修改己國DRIs 之亞洲國家，本篇研究綜整 所有用來發展日本最新DRIs(DRIs-J 2010)之科學性文獻，目的是釐清當前重要 議題並剖析亞洲DRIs 之未來展望。DRIs-J 2010 中訂定成人參考值的標準與研究 主要摘錄自DRIs-J 2010 報告，並根據DRIs 中的類型，將每一營養素予以系統 性分類並匯整於表中。分類項目如下：量測標準、對象種族、出版年份、研究 型態與設計、樣本數及研究內容。在所有文獻中，共挑出184 篇，並將DRIs-J 2010 中的部分議題分成以下幾點說明：1) 部份營養素缺乏以當地族群為主之研 究；2) 部分營養素僅賴少數或早期幾篇研究來決定其上限容許攝取量；3)制定 相同DRIs，營養素之量測標準卻不一致。以上這些常見議題亦是其他亞洲國家 訂定DRIs 時會遭遇到。建立DRIs 時，除了族群之健康狀態和國家特定之需求 外，這些議題也需納入考慮。

Midwives are actively involved in providing dietary advice to pregnant women. In order to describe the current status of prenatal dietary advice provided by midwives, we conducted a questionnaire survey inquiring about their knowledge and usage of the "Dietary Guidelines for Pregnant and Lactating Women" (Guidelines) issued by the Ministry of Health, Labour, and Welfare in 2006.In total, 2000 members of the Japanese Midwives' Association were randomly selected for administration of the questionnaire. The recovery rate was 42.1%, and 785 responses were eligible for analyses. The questionnaire collected information on the respondent's age, years of work experience, current involvement in delivery practice, number of deliveries per year in the current affiliation, provision of dietary advice to pregnant women, and knowledge and usage of the Guidelines.The proportion of respondents in their 20 s was low (1.8%). About half of the respondents were practicing delivery. Further, 66.1% (519 midwives) reported they had knowledge of the Guidelines. Among those who had knowledge of the Guidelines and were currently providing dietary advice (426 midwives), 88.0% were using the Guidelines. The most frequently used item in the Guidelines was "Diet for preventing anemia" (75.8%). The least used item was "Shoku-iku (diet and nutrition education) for pregnant and lactating women" (58.5%). Midwives who were practicing delivery showed a significantly lower usage of the Guidelines than those who were not (84.9% vs. 92.6%, P = 0.02). Among midwives practicing delivery, the most common reason for not using the Guidelines was "using original educational material produced by oneself or the facility."Providing dietary advice to pregnant women constituted a large fraction of midwives' duties as well as delivery practice. About 90% of the midwives, who had knowledge of the Guidelines and provided dietary advice, were using the Guidelines. In order to increase the usage of individual items of the Guidelines, ready-to-use brochures should be developed for midwives.

We investigated the characteristics of dietary supplements and their use by 1,076 Japanese pregnant women, the majority of whom were in mid- to late pregnancy. The subjects completed a self-reported survey on their sociodemographic characteristics, supplement use, and attitudes towards diet. The overall prevalence of supplement use did not change before and after pregnancy (75%); however, daily use increased by approximately twofold with pregnancy (20.2% versus 37.2%). After the onset of pregnancy, supplements containing folic acid were taken for fetal health. Daily users were more likely to be older, have a greater awareness of the risk of neural tube defects (NTD), view supplement use as acceptable, have less diet anxiety, and have more advisers regarding diet. Respondents used supplements containing folic acid alone or with other ingredients. Folic acid intake is recommended to reduce the risk of NTD. However, supplement use began after pregnancy recognition, suggesting a lack of knowledge on the appropriate timing of folic acid use. Information about supplements was obtained mostly from newspapers, magazines, flyers, and stores. These results indicate that more accurate information regarding the optimal timing of folic acid intake and the safety of dietary supplements must be disseminated.

We conducted a survey of tuberculosis (TB) treatment and community Directly Observed Therapy, Short-course (DOTS) practice of doctors at the medical facilities designated for TB treatment in the Tama area, Tokyo, to determine the current status and issues of community DOTS and to enhance cooperation between public health centers and medical institutions.A self-administered questionnaire was sent by postal mail to 500 medical institutions selected through stratified random sampling in each public health center region.We received 287 (57.4%) replies. Of these, 169 (58.9%) had not treated TB patients in the previous 2 years. A total of 48.8% of the doctors were aware of DOTS, and 2.8% were currently conducting DOTS, while 18.7% wanted to conduct DOTS. In contrast, 51.2% had barriers to conducting DOTS, and 27.2% had no plans to conduct DOTS. Knowledge of DOTS was correlated with the future possibility of conducting DOTS and with the use of medication diaries. Doctors in private clinics had lower participation rates in seminars compared to those doctors in hospitals.In order to expand DOTS it is necessary to provide private doctors with educational tools with which doctors can update their knowledge of TB treatment.

Folate is a water-soluble B vitamin that is essential for various one-carbon transfer reactions including formate oxidation, amino acid metabolism, and biosynthesis of thymidylate and purines. The term “folate” represents all folate derivatives, including its synthesized form, pteroylglutamic acid (folic acid, FA). In humans, folate is known to be absorbed from the upper-small intestine. The bioavailability of FA is estimated to be 1.7 times higher than that of natural food folate. In recent years, folate has received enthusiastic attention because of its preventive effects on fetal neural tube defects if given periconceptionally. In addition, folate became one of the hottest nutrients of research interest in the last two decades, since elevated serum or plasma homocysteine has been implicated as a risk factor for occlusive vascular disease, and its metabolism is closely regulated by folate. Although we need to understand intricate metabolic changes of folate associated with human pregnancy, we do know that folate requirement increases during pregnancy to support fetal growth. To meet this increased demand, folate is actively transferred to the fetus across the placenta. The findings in many human studies are inconsistent in terms of the association of birthweight (considered to be the best assessment of fetal growth) to maternal dietary folate intake, biomarkers of folate status, and the effect of FA supplementation. We suggest that systematic and well-designed studies be performed to better understand folate metabolism during pregnancy and the critical period for adequate folate status to achieve optimal fetal growth.

Adequate weight gain in pregnancy is essential for the health of the mother and developing fetus. However, a woman's self-beliefs regarding body shape and weight gain may become a driving force toward unnecessary dietary restriction during pregnancy. In order to assess the current status of self-beliefs, attitudes toward pregnancy related changes, and dieting behavior in pregnant women, a questionnaire survey was conducted at a prenatal clinic in Tokyo. A self-administered questionnaire was distributed to 500 women and 248 women responded with eligible data. Nearly all respondents (91.5%) stated that they knew their own weight gain targets. Thirty-four women (13.7%) reported dieting before being pregnant, and 88 women (35.5%) reported current dieting. Seventy-eight of the current dieters were doing so based on self-judgment, and only fifteen were following a dietician's advice. The majority of the respondents (69.0%) believed that smaller babies would help a smooth delivery. From multivariable logistic regression analysis, the odds ratio (OR) for current self-judged dieting was significant in women who had dieted before pregnancy (OR: 4.67, 95% confidence intervals (CI): 2.10-10.4), and those who desired smaller babies for a smooth delivery (OR: 2.73, 95% CI: 1.35-5.52). Obstetricians, midwives, and dieticians should be aware of previous dieting history and self-beliefs in pregnant women, in order to give professional advice about the importance of adequate weight gains.

Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids.Study subjects consisted of 103 infants who were born vaginally at term, with birthweight2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty-four infants were breast-fed and 36 were formula-fed at 6 months.Breast-fed infants demonstrated similar growth patterns compared with partially breast-fed or formula-fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol.Japanese breast-fed infants were more likely to be anemic at 6 months, while formula-fed infants were likely to have low serum lipid levels. Iron-fortified infant foods may be useful to prevent anemia in breast-fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula-fed infants.

Greater antenatal weight or body mass index (BMI) gains may lead to larger fetuses and thus increase the risk for operative deliveries, such as cesarean deliveries. In order to examine the effect of weekly maternal weight and BMI changes on large-for-gestational-age (LGA) infants and cesarean delivery, delivery records from overall healthy women were analyzed.Singleton, term delivery records from January to December 2003, at three obstetric departments (urban, suburban, rural) in Japan (1617 records) were analyzed. Multivariate logistic regression analyses were applied in order to estimate the effect of maternal pre-pregnancy body size, higher maternal weight or BMI gains by calculating the odds ratios for LGA infants and cesarean deliveries.Maternal pre-pregnancy overweight, primiparity, and BMI gains of more than 0.13 per week were independent factors positively related to LGA, and maternal underweight was negatively related. Urban hospital setting, maternal age 35 years or older, primiparity, and BMI gains of more than 0.13 per week independently increased the odds ratios for cesarean delivery. Weight or BMI gains between two-week intervals (26-28 weeks, 32-34 weeks) were not useful for predicting either LGA or cesarean delivery. LGA was unrelated to cesarean delivery risk.Applying BMI gains per week enables target weight gains to be set according to the mother's height, which may be useful in reducing risks for LGA and cesarean delivery, especially in shorter women. Further investigation may be needed to explore the practicality and effectiveness of advising women to gain weight according to their body height.

We have presented BMI reference data for Japanese children using the LSM method (1), where L, S and M values were smoothed by one or two segments of polynomial functions with nonsmooth connection, which was the barrier for adequate evaluation of BMI for children. So, we smoothed L, S and M values by cubic spline with several knots that are presented in this report.